EFFECTIVENESS of HEALTH EDUCATION:

• Educational interventions, even if perfectly planned and

implemented, will fail if the patient or client does not follow through
or continue with the behavior changes. After all is said and done ,
changing behavior is a voluntary activity.
• Clients can be taught what to do, but it is up to them to do it.
Health education interventions do work, and they work well.
Hathaway’s (1986) meta analysis of 68 studies on the effects of per
operative education on postoperative outcomes revealed that 67
percent of clients who received preoperative instruction had more
favorable surgical outcomes.
• In a Meta –Analysis conducted by DEVINE (1992), 191 studies were
examine for the effects of education on surgical recovery. This
investigation found education to have beneficial effects on recovery ,
pain, and psychological distress.
• The goal of any intervention is to meet the educational needs of the
client, increase the likelihood of compliance, and ultimately, improve
health status.

• LITERACY and READABILITY:

• Skills needed by patients/clients
• Printed educational materials are used for many purposes in te
health care field.
• We provide patients with educational pamphlets or booklets to
supplement the oral teaching that is done.
• We give instruction sheets for taking medications or carrying out
treatments.
• We also expect patients to fill out admission forms, read and sign
consent forms, and read medication labels and appointment slips.

• ASSESSING LITERACY:
• People with low literacy often inadvertently give us clues that can
lead us to realization that they may have a reading or comprehension
problem.

• Such clues include:

• Such clues include:
• Not even attempting to read printed material
• Asking to take PEMs home to discuss with a significant other
• Claiming eye glasses were left home
• Stating that they can’t read something because they are too tired
or don’t feel well.
• Avoiding discussion of written material or asking no question about
it.
• Mouthing words as they try to read.
• The following clues may give you some leads as to a patient’s
literacy and maybe all you can do in some situations , actually
measuring literacy levels is a better approach.

• Two Tests are often used to measure patient literacy:

• 1. REALM ( Rapid Estimate Of Adult Literacy in Medicine)

• 2. WRAT (Wide Range Achievement Test).

• Both tests measure the basic reading skill of decoding words (

recognizing letters that form words and then pronouncing the
words correctly.)
•
• Only 2-3 mins. to administer the tests, which makes clinical use of
the tools flexible.
• The REALM is a reading test that requires patients to pronounce
common medical and anatomical words .
• T he test “ contains 66 words arranged in three columns in
ascending order of number of syllables and increasingly difficulty”.

• Teaching Patients with Low Literacy Skills:

• Assessing reading ability is only the first step in the process of health
education for people with low literacy skills.
• The second step is planning an approach to teaching that will best
meet the needs of the individuals in this group.
• First ,it is important to set objectives that are realistic for the
person’s level of understanding .
• Objectives should focus on basic essential skills that must be
achieved if safety is to be maintained.
• The objectives should be shaped by what the person already knows
about the topic as well as by what he or she still needs to learn.
• Teach limited amounts of material during each session.
• Keep instruction simple by breaking them down into smaller units.
• Ex. If teaching about taking digoxin, first teach a little about the
action of the drug , then teach how to take pulse rate then about the
need for follow up visits.
• Developing Printed Educational Materials
•
• Organizational Factors:
• 1. Include a short but descriptive title
• 2. Use brief headings and sub headings
• 3. Incorporate only one idea per paragraph , and be sure the first
sentence is the topic sentence.
• 4. Divide complex instructions into small steps
• 5. Consider using a question/ answer format
• 6. Address no more than three or four main points
• 7. Reinforce main points with a summary at the end
• Linguistic Factors
• 1. Keep the reading level at grade 5 or 6 to make the material
understandable to most low literate persons.
• 2. Use mostly one or two syllable words and short sentences
• 3. Use a personal and conversational style. Ex. “ you should weigh
yourself everyday” is preferable to “ The person with congestive
heart failure should measure the body weight everyday”.
• 4. Define technical terms if they must be used.
• 5. Used words consistently through out the text. Ex. Stay with the
word pill rather than switching between pill and medicine
• 6. Avoid the use of idioms that might mean different things to
different people. Ex. The term junkfood may not be clear to all
people.
• 7. Use graphics and language that culturally and age relevant for
the intended audience.
• 8. Use active rather than passive voice; ex. “ take one pill every
morning”
• 9. Incorporate examples and simple analogies to illustrate
concepts.
• Appearance Factors
• 1. Avoid a cluttered appearance by including enough white space
• 2, Include simple diagrams or graphics that are well labelled.
• 3. Use upper and lower case letters. All capitals are difficult for
everyone to read.
• 4. Use 10-14 point type in a plain font ( serif is preffered)
• 5. Placed emphasized words in bold or underline them , but do not use
capitals because they are difficult to read
• 6. Use lists when appropriate
• 7. Try to limit line length to no more than 50 or 60 characters

•
• PART 111
• TRADITIONAL TEACHING STRATEGIES:
• Lecturing
• There is a cartoon described by Zacchry (1985) in which a teacher is
telling her students, “ okey class , my job is to talk and your job is to listen.
• If you finish first, let me know.
• The concern is that because the students are passive listeners, they
“tune out” before the end of class and miss important information.
• In the days of Socrates and Plato, lecture were a means of
conveying facts, information, and ideas that could not readily
obtained elsewhere.
• Books, charts, and tapes were not available , so the lecture became
an essential means of teaching..
• Purposes of lecturing:

• Can be used to stimulate student’s interest in a subject

• Lecture can also be used to inspire people
• To integrate and synthesize a large body of knowledge from
several fields of or sources

• Advantages of the Lecture Method:

• Economical
• One way verbal communication that occurs during a lecture is that
it helps students develop their listening abilities.
• Stunkel (1998) asserts that students must discipline themselves to
listen, remember, track arguments ,decide what to take notes on
and relate what is being said to the assigned reading.
• It serves as a good purpose and not just because they don’t want
to take the time to develop another teaching strategies.

• Disadvantages of the Lecture Method:

• By nature it lends itself to the teaching of facts while placing little

emphasis on problem solving, decision making, analytical thinking,
or transfer of learning.
• Lecturing is not conducive to meeting student’s individual needs
• Students are limited to learning from an authority figure and
learning by the stimulation of only one of the senses—hearing.
• Students have no opportunity to learn from peers, to learn by
manipulation of data, to discover, to learn visually or through touch.
• Limited attention span on the part of the learners

• Organizing the Lecture:

• Planning of the lecture well ahead of the time of delivery is time
well spent because a lecture thrown together at the last minute
appears to be just that.
• You need to take time to plan the objectives of the lecture , gauge
how much time it will take to cover the content, and consider the
difficulty of the material and ability of the audience.
• Once you are clear on the objectives and the level of depth to which
you will go on with the content, it is time to start a written outline.

• Delivering the Lecture:

• The planning and organizing of content are finished, It’s time to
deliver the lecture.
• You need to plan your delivery , rehearse, and consciously think about
your techniques of delivery if you are to maximize your effectiveness.
• Controlling Anxiety
• If you are anxious about giving lecture , you need to think about
controlling your anxiety. An effective control is” imaging”, with
imaging you visualized yourself as you want to appear to your
audience.
• Spontaneity
• Avoid reading to the class, reading kills all spontaneity and can be
anesthetizing. Do not write your lecture out in full sentences. If your
notes are in the form of lists and phrases you will have to think
during the delivery and spontaneity will increase.
• Voice Quality
• If your voice is not loud enough for everyone in the class to hear
easily, use a microphone. Beware of lecturing in a monotone, the
audience will put them to sleep than with a monotone voice.
• Body language
• You can add to the dramatic quality of your lecturing by your
movements.
• Do not stand glued to one spot. Move to the side occasionally or
stand in front of the podium ( this proves you are not bound to your
notes) or even sit on the desk for a while.
• Keeping your arms folded or wringing your hands or playing with a
piece of chalk indicate to your audience that you are nervous.
• Speed of Delivery
• The pacing of a lecture affect’s both the learner’s comprehension
and enjoyment of the material .
• Too slow a pace can induced boredom , but too fast a pace can result
in writer’s cramp for students as they struggle to take notes and to
understand what is being said.
• Getting Off on the Right Foot
• To begin a lecture sets the tone for all that follows.
• Try to avoid just walking into the class and immediately launching
into the lecture.
• Try to give an opening “ attention getter”. Starting with “
provocative questions , startling statement, powerful quote, or
mention of a recent news event.
• Clarifying During the Lecture
• Clarification can be done effectively by means of examples and
analogies rather than repetition.
• Facilitating Retrieval from Memory
• One method is repetition. Elaboration is another form of repetition.
Imagery by which information can be lodged in a memory for later
retrieval.
• Types of Lecture:
• Traditional oral essay—in this type , the teacher is an orator and is
the only speaker . The class consists of a complete polished
exposition on a topic that can be inspirational and informative.
• Participatory lecture-- begins with learner’s brain storming ideas
on the lecture topic based on what they have read in preparation.
• Lecture with uncompleted handsout—involves a somewhat
traditional oral essay format.
• The learner are supplied with handsout containing the lecture
outline in some details with blank spaces for learners to fill in
information
• Feedback lecture-- consist of mini lectures interspersed with 10
mins. small group discussions structured around questions related
to the lecture content.
• This gives the learner the opportunity to manipulate the lecture
content and apply immediately enhancing learning and memory call.
• DISCUSSION:
• Class discussion made formal or informal.
• FORMAL discussion - the topic is announced in advance and the
class is ask to prepare to take part in discussion by reading certain
materials or watching video tapes.
• INFORMAL discussion -- may take spontaneously at any point during
the class including at the end of a lecture when the teacher asks, “
is there any questions”?
• Purposes and advantages of Discussion
• To give the learners an opportunity to apply principles, concepts,
theories and in the process to transfer their learning to a new and
different situations.
• Clarification of information and concepts.
• Advantage of the discussion method is that many students like it
and may even prefer it to other methods.

• Disadvantages of the Discussion Method

• Discussion takes a lot of time
• Lecture or computer assisted instruction are superior in terms of
time efficiency
• Discussion Techniques
• Good discussions do not usually happen spontaneously ; they
require careful planning. The teacher must develop objectives and
choose appropriate topic

• Techniques to Facilitate an Effective Discussion:

• Make your expectations clear – The learners should know exactly
what they have to do to prepare for discussion and to what degree
they are expected to participate.
• Set the ground rules--- include time limits for various aspects of the
discussion , prohibitions against interrupting someone , or limits the
number of times any one person may speak.
• Arrange the physical space---
• The classroom will permit chairs to be arranged so everyone can sit
in a circle.
• The more eye contact among participants the better the possibilities
for a good discussion
• Plan a Discussion starter--
• include referring to study questions that you handed out at a prior
meeting asking the participants to come to the discussion with some
opening questions prepared.
• Facilitate, don’t discuss ---
• If you are taking the role of the leader you should refrain from
doing much talking. You need to be free to watch the group process,
keep the discussion moving and make sure everyone is engaged in the
process.
• Encourage quiet group members--
• Helping a quiet or shy people to, participate is a challenge. It helps
to make eye contact with them and smile and direct simple
questions to them or draw on their personal experiences or expertise.
• Don’t allow monopolies---
• You should discourage members who are talking too much and not
letting others take part.
• Direct the discussion among group members–
• Part of the leader’s role is to direct the discussion between and
among the members of the group; most comments should not be
addressed directly to the leader .
• . If everyone looks and talks to the leader , the leader is going to be
much too verbal.
• Your interventions should serve only to support the group process
and introduce comments or questions that will move the discussion
along and accomplish the objectives.
• Keep the discussion on track--
• If people are going off on a tangent and don’t seem to be finding the
way back , you should make a comment like “ we seem to have
strayed a little from a topic . Let’s pick up on the last point that Juan
was talking about.
• Clarify when confusion reigns---
• in the course of discussion , the leader may need to clarify
participant’s statement in order to avoid confusion and information
• Tolerate some silence---
• Many people are uncomfortable with silence in a group settings ,
silence gives everyone a chance to think about what has been said
and to organize his or her thoughts.
• Summarize when appropriate---
• A summary maybe in order when moving from one aspect of a topic
to another and certainly needed at the end of the discussion period.

• QUESTIONING:
• Functions of questioning:
• Questions can be used to assess a baseline of knowledge to find out
what a group already knows about the subject.
• Questioning can also be used to review content.
• Levels of questions:
• Convergent questions –
• requires the learner to recall or integrate information they have learned.
Have specific usually short and expected answers.
• Divergent--
• questions ask the learner to generate new ideas , draw implications, or
formulate a new perspective on a topic.. There is no single correct answer
• Lower –order questions---
• those that require the learner to recall information they have read or
memorized
• Higher- order questions –
• require more than recall. The learner would have to be able to
comprehend or think critically about the information